Too many times after an obstetric-gynecologic exam, Horowitz was headed out the door when a female patient offhandedly pretended to remember to ask a question.

Typically, it was a question about sexual health: Lack of libido. Painful sex. Vaginal dryness. No orgasms.

“For many years, I said the same thing that many doctors still say to women: ‘Well, you’re busy. You’re a wife. You’re a mother. It’s hard to feel sexy when the laundry needs doing,’ ” explained Horowitz of Royal Oak Beaumont Hospital. “I always felt I was shortchanging them.”

Several years ago, Horowitz, a 32-year veteran ob-gyn, decided to tackle the issues directly and boost her training in female sexual health.

“I started asking patients and the responses were overwhelming in terms of the problems that they were having,” said Horowitz, the founder of the Center for Sexual Wellness in Farmington Hills.

Despite the countless ways sex saturates our culture — from overt mentions in music and on TV to ads touting male performance boosters — talking about sex mechanically and medically can be awkward, especially for women.

Studies show that anywhere from 40% to 75% percent of women have a sexual health concern, regardless of age. And other studies show doctors rarely ask about the issue or delve into details to answer patients’ questions. Horowitz said she used to be one of those doctors.

Among the questions she hears are: “I’m having pain during sex” or “I’d rather go to bed with a book.”

“What’s wrong with me?” they ask.

If they’ve come to one of Horowitz’s past seminars, the women asking the questions know they’re not alone. Last year, Horowitz partnered with a restaurant owner for a dinner and sexual health seminar linked to the popularity of the erotic book “Fifty Shades of Grey.” She says she wants to stage another session when the movie of the same name is scheduled to be released early next year.

Elana Gottfried, a certified sex therapist and clinical social worker with the Center for Relationship and Sexual Health in Royal Oak, specializes in treating women who worry about low sexual desire, or have chronic pelvic pain associated with intercourse.

“Awareness about sexual health has definitely risen, but it’s still a hard topic to bring up,” said Gottfried, who also has a Livonia office.

When women seek her out, says Gottfried, the problems “have been going on for a long time, and they haven’t sought help because of embarrassment or shame or a (bad) experience with a doctor’s bedside manner.”

What women need to understand, said Sallie Foley, a psychotherapist and sex therapist educator at the University of Michigan, is that there is treatment and therapy available to alleviate the typical difficulties.

Historically, men’s sexual health issues have dominated research, said Foley, the former director of the UM Center for Sexual Health and co-author of “Sex Matters for Women: A Complete Guide to Taking Care of Your Sexual Self.”

Medical professionals “had mapped all the nerves and named them in the male reproductive system by the 1930s,” said Foley. “It took until the 1990s for a similar mapping of women’s genital area,” said Foley, who credits one of her University of Michigan colleagues, ob-gyn researcher, Dr. John DeLancey, for the work.

Earlier this month, about 60-plus health care groups and university researchers signed an open letter to the U.S. Food and Drug Administration, urging the government agency to approve the first-ever drug to treat the most commonly reported form of female sexual dysfunction, hypoactive sexual desire disorder (HSDD) or low sexual desire.

There are 26 approved drugs for men’s lax libido, the signers said, and zero for women.

Although most women recognize male sexual disorders, such as erectile dysfunction, only a fraction of women know there’s a diagnosis for the sexual dysfunction they may have experienced, a recent survey showed.

Only 14% of more than 1,000 U.S. women between the ages of 30 and 50 knew about HSDD, according to the April survey commissioned by the nonprofit HealthyWomen and a pharmaceutical company developing a treatment for the condition.

Lack of sex can create tensions in romantic partnerships, shutting down intimacy and communication, and impairing women’s self-esteem as they blame themselves for the breakdown, said Foley. Many women don’t realize low sexual desire can stem from medical conditions and even common medications.

“There’s this idea that women want to be magically carried off into the bedroom” to spark arousal, explained Foley. But even when women don’t initially feel in the mood, said Foley, women may want to make time and effort for sexual intimacy.

“Don’t expect it to look like Madonna in one of her musical videos singing “I want it. I want it,” said Foley, referring to a lyric in the Michigan-bred pop star’s 1989 song “Hanky Panky.”

“Instead, think that once I start being touched and touch my partner,” said Foley, “my body will remind me of how much I want it.”

And their partners, said Foley, need to realize that mutual seduction and satisfaction starts in places other than the bedroom.

“People change their rules in permanent partnerships, and they have to talk to each other about resentments and the work that relationships take.”

“It’s work to have a good sex life,” said Foley, “but it’s good work to do.”

Patricia Montemurri is a reporter for Detroit Free Press.

Frequent sexual health issues women face

Low sexual desire: “Most medical issues can cause sexual side effects,” said therapist Elana Gottfried. Antidepressants, high blood pressure pills, heart medications, prescriptions to treat attention deficit disorder are among medications that can lessen desire. Surprisingly, many birth control pills, can cause problems, because they suppress the sex-related hormones estrogen and testosterone.

Menopause: Menopause can be liberating for women who may no longer worry about unintentional pregnancies. At least 61% of women ages 50 to 59 were sexually active and 45% of women ages 60 to 69 and 28% of women 70 to 79 were active, according to recent surveys by the Women’s Health Initiative. Of those, some two out of three were satisfied with their sex lives.

Painful intercourse: Even allergy medication such as antihistamines can dry up the mucus membrane of the vagina. The hormonal changes of menopause also can affect the suppleness and sensitivity of the vulvo-vaginal area. Symptoms of vulvo-vaginal atrophy include dryness and irritation, which can cause pain with sex. Nearly half of postmenopausal women, have experienced vaginal symptoms and irritation, according to recent studies, and about as many didn’t know about available therapies to treat it, such as prescription topical estrogen creams. Talk to your doctor about using the estrogen creams. In some cases, they may not be suitable for women who’ve dealt with breast cancer.

Some women with chronic pelvic pain may have a condition known as pelvic floor muscle dysfunction, as muscles tighten in pain during sexual penetration.

It is both a physical condition with a psychological component, and often is linked to issues of sexual abuse and mistreatment, said Gottfried. Both physical therapy and psychological counseling can help.

How to get help

■ University of Michigan sex therapy educator Sallie Foley maintains an informative website that includes charts with details about artificial and natural lubricants and arousal gels at www.salliefoley.com. Foley’s tip for doing online research — while avoiding pornography sites — is to use the search terms “sexual health” rather than the word sex. To be specific, add other search terms such as “menopause” or “after baby.”

■ To find certified sex therapists and sex counselors in your area, the American Association of Sexuality, Educators, Counselors and Therapists maintains www.aasect.org.

■ Questions about sexual health directed at young women in their teens and 20s are answered at www.scarleteen.com.

■ Take a quiz about female sexuality through the website of Association of Reproductive Health Professionals: www.arhp.org/sexlife/. “Did you know that great sex doesn’t necessarily come from below the belt?” says the introduction, adding that the quiz “will help you consider how your life, love, health, relationships, and well-being are contributing to healthy sexuality.”